Provider Demographics
NPI:1568670875
Name:WASHINGTON, MARY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 LINCOLN JONES RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1828
Mailing Address - Country:US
Mailing Address - Phone:404-494-6764
Mailing Address - Fax:404-228-3064
Practice Address - Street 1:3851 LINCOLN JONES RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1828
Practice Address - Country:US
Practice Address - Phone:404-494-6764
Practice Address - Fax:404-228-3064
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177351163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health